Provider Demographics
NPI:1295482719
Name:LEDKINS, SOMMER LONG
Entity type:Individual
Prefix:
First Name:SOMMER
Middle Name:LONG
Last Name:LEDKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOMMER
Other - Middle Name:RENEE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 COUNTY ROAD 2320
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-3658
Mailing Address - Country:US
Mailing Address - Phone:903-312-5565
Mailing Address - Fax:
Practice Address - Street 1:619 S FLEISHEL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2004
Practice Address - Country:US
Practice Address - Phone:903-606-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX830380163WC0200X
TX1075174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine